Point-of-care ultrasound has garnered much attention in nephrology recently. However, there remains a high barrier for entry with significant kinesthetic and cognitive knowledge required to obtain and interpreting limited ultrasounds. Practical knowledge in building infrastructure for machine acquisition and maintenance, as well as in image archiving and quality assurance is limited to a few experts. Indeed, billing and coding for point-of-care ultrasound by the nephrologist remain unexplored in medical literature. A course for complete diagnostic kidney and bladder ultrasound has existed for some time, but training in limited studies is a more recent development. Recently, I have had the pleasure of helping facilitate ultrasound courses specifically designed for the nephrologist looking to develop skill in point-of-care ultrasound.
1. National Kidney Foundation Spring Clinicals: Point-of-Care Ultrasound for the Nephrologist
Taking place annually at the National Kidney Foundation Spring Clinical Meeting this is the original point-of-care ultrasound for nephrologists course. Founded in 2016 by Daniel Ross, Kenar Jhaveri, and Paul Mayo, this course features half-day courses of about 30 students each with alternating didactic sessions with case-based learning and hands-on session using ultraportable devices and volunteer subjects. This course emphasizes how lung ultrasound can be used to measure fluid overload in patients with kidney disease and features inferior vena cava assessment and basic kidney ultrasonography. Next March 25-29th, 2020 at the Ernest N. Morial Convention Center in New Orleans, LA http://www.kidney.org/spring-clinical
2. KIDNEYcon: Vascular Ultrasound for the Assessment of Volume Status
KIDNEYcon is an annual conference featuring the latest updates in kidney medicine paired with half-day hands-on workshops. KIDNEYcon is unique among conferences paying special attention to building enthusiasm among residents and fellows, facilitating collaborative research projects and fostering camaraderie in an intimate setting. Initially founded by nephrologist Nithin Karakalla and intensivist J. Terrill Huggins, the Vascular Ultrasound for the Assessment of Volume Status emphasizes hands-on one-on-one learning experiences with experts in point-of-care ultrasound in nephrology paying specific attention to focused cardiac assessment including inferior vena cava and lung ultrasound. Next April 16 – 19, 2020 at the University of Arkansas Medical Center in Little Rock, AR.
3. Cardio Renal University Point-of-Care Ultrasound Immersion Course
The annual Cardio Renal University Point-of-Care Ultrasound Immersion Course brings students from across the country to a surrounding conducive to introspection and intensive learning in handheld sonography techniques. The course is held annually at the combined Southwest Nephrology Conference and Cardio Renal Metabolic Conference. Affiliated with the National Kidney Foundation of Arizona, the mission of the Cardio Renal Society of America (CRSA) is to support cross-disciplinary collaborations and raise awareness for patients suffering with these multi-system disorders. This course emphasizes immersion through intensive, but focused classes alternating between case-based didactics and one-on-one, hands-on sessions with leading point-of-care ultrasound nephrology experts. The course runs 2 days with 12 hours of didactics and covers basic and advanced focused echocardiography as well as lung, kidney and bladder, and more advanced vascular ultrasound. Next March 6 – 7, 2020 at the We-Ko-Pa Resort and Conference Center in Scottsdale, AZ.
While there are now dozens of course offerings encompassing a variety of lengths and formats for all skills levels, I’d like to highlight a couple of offerings for learning point-of-care ultrasound for the broader internal medicine community.
4. American College of Physicians (ACP)
Nephrologists are—in their heart-of-hearts—highly skilled internists. The American College of Physicians is the largest medical-specialty organization and second-largest physician group in the United States. Point-of-Care Ultrasound is now a yearly happening at the ACP Internal Medicine Meeting next held April 21-25, 2020 in Los Angeles, CA. ACP has really upped its game with 3 offerings for point-of-care ultrasound courses.
a. Point-of-Care Ultrasound for Beginners: part of the Clinical Skills Center costing only $20 in addition to conference registration for a one-hour hands-on session with experts in the field available April 23-25th.
b. Point-of-Care Ultrasound: Foundational Skills for Internists: hosted by the acclaimed Renee Dversdal, MD, FACP and David Tierney, MD, FACP, this 2-day course features small-group hands-on format focusing on lung, cardiac, kidney, abdominal free fluid, and DVT studies. Available April 21-22nd.
c. Point-of-Care Ultrasound: Advanced Skills for Outpatient Practice: Building on the intermediate skill-level course, this is a 1-day course hosted by Michael Wagner, MD, FACP featuring alternating didactic lectures and small-group hands-on training feature more advanced exams including multisystem ultrasound, AAA screening, gallbladder, skin and soft tissue, and musculoskeletal ultrasound. Available April 22nd.
Additionally, this year’s ACP features clinical skills sessions on image review quality assurance as well as ultrasound-guided central line and lumbar puncture skills labs.
5. American Institute of Ultrasound in Medicine (AIUM)
Medicine is nothing if not subspecialized. Is it not unsurprising that ultrasound should have their own journals, societies, and annual conferences? The American Institute of Ultrasound in Medicine is the preeminent entity and the AIUM 2020 Annual Integrative Ultrasound Meeting is the place to be to learn about point-of-care ultrasound. With attendees from across the spectrum of healthcare representing more than 20 specialties, this meeting is the very definition of interdisciplinary. And with more than 150 session offerings, the number of unique experiences is virtually limitless. Hosted March 21-25th, 2020 this year at the New York Hilton Midtown, NY, this conference is the ultimate in hands-on and didactic point-of-care ultrasound experiences. See for yourself!
Regardless of how you learn, it is critical to have a longitudinal experience to continue to reinforce what you learned and build on your experiences. This is most feasible at your home institution. Look for friends in emergency medicine and critical care. Attend their conferences and image review sessions. Make friends with sonography techs for additional hands-on experiences. Stay up to date with the Renal Fellows Network’s Focus on POCUN series with Abhilash Koratala.
Assistant Professor of Medicine
University of Pennsylvania